This Is Your Country on Drugs

Melody Petersen talks about how we’re hooked on Big Pharma.

George Kenney

“I think some of the top pharmaceutical executives should face criminal charges,” says Melody Petersen, author of Our Daily Meds.(Photo by:Molly Hawkey )

Melody Petersen has been writ­ing about the phar­ma­ceu­ti­cal indus­try for more than 10 years, includ­ing as a staff reporter for the New York Times. Her recent book, Our Dai­ly Meds: How the Phar­ma­ceu­ti­cal Com­pa­nies Trans­formed Them­selves into Slick Mar­ket­ing Machines and Hooked the Nation on Pre­scrip­tion Drugs (Far­rar, Straus and Giroux, 2008), should be required read­ing for any­one who’s seri­ous about health­care reform.

The drug companies focus on maladies like depression and high cholesterol and anxiety—they are not interested in cures.

What is the most out­ra­geous thing you have seen while cov­er­ing the drug industry?

I went to a con­fer­ence where the title of one talk that jumped out at me was Cre­at­ing a Dis­ease.” A drug com­pa­ny exec­u­tive got up on stage with a Pow­er­Point pre­sen­ta­tion and explained how his com­pa­ny had cre­at­ed a dis­ease – over­ac­tive blad­der. The com­pa­ny owned a pill for incon­ti­nence, but the mar­ket for incon­ti­nence is very low because most­ly elder­ly peo­ple suf­fer from it, and doc­tors try to man­age this in a non-phar­ma­ceu­ti­cal way. Even though this drug works on your blad­der, it is very hard on your brain. It can cause severe mem­o­ry prob­lems. But the com­pa­ny want­ed to expand the mar­ket so it cre­at­ed this dis­ease called over­ac­tive blad­der” or OAB,” which it defined as need­ing to go to the bath­room more than nine times a day. And now you see ads for this drug, Detrol, for over­ac­tive blad­ders. It became a blockbuster.

As you say in the title of your book, it’s all a huge mar­ket­ing machine. In Europe and Cana­da they pay less for drugs and take few­er.

Two-thirds of men, women and chil­dren in the Unit­ed States take at least one pre­scrip­tion drug. And chil­dren in the Unit­ed States are three times more like­ly to take anti-depres­sants and psy­chi­atric drugs as chil­dren in Europe. We spend at least $300 bil­lion a year on pre­scrip­tion drugs. That is about twice than what we spend on high­er education. 

The Unit­ed States ranks 50th in life expectan­cy, accord­ing to the CIA. Today a 65-year-old Mex­i­can man will live longer than a 65-year-old Amer­i­can man. How impor­tant are those inter­na­tion­al comparisons?

We are pay­ing more in health­care per per­son than any oth­er coun­try. In our econ­o­my, almost one out of every five dol­lars is spent on health­care, and it con­tin­ues to rise at a rate greater than infla­tion. You would think that with us spend­ing so much, we would be at the top of the life expectan­cy ranking.

The implic­it argu­ment is that in addi­tion to all the oth­er prob­lems, we are suf­fer­ing from an excess dosage of drugs. This goes back to the mar­ket­ing. What does the bulk of the mar­ket­ing go into?

Most of the mar­ket­ing dol­lars are spent on physi­cians. When the drug ads on tele­vi­sion say, Ask your doc­tor about this drug,” the drug com­pa­nies have already been to your physi­cian and made sure he or she was ready to pre­scribe it. A sur­vey of physi­cians a cou­ple years ago found that more than nine out of ten had recent­ly tak­en some sort of gift or cash from the drug com­pa­nies. And many doc­tors are tak­ing hun­dreds of thou­sands of dol­lars a year from these drug com­pa­nies, work­ing as con­sul­tants and advisers. 

You write that these drug com­pa­nies are not devel­op­ing drugs that could be more use­ful in the world, but drugs that could be more prof­itable here at home.

That is one of the tragedies about this sit­u­a­tion. The drug com­pa­nies focus on mal­adies like depres­sion and high cho­les­terol and anx­i­ety – things that impact large por­tions of the Amer­i­can pub­lic. They are not inter­est­ed in cures, because if you cure some­body of the dis­ease they don’t take the drug for long peri­ods of time. 

And they are not inter­est­ed in trop­i­cal dis­eases like malar­ia. Peo­ple in Africa des­per­ate­ly need med­i­cine, but the drug com­pa­nies know Africans are too poor to pay for the med­i­cines. They want to sell drugs to Americans. 

There is no incen­tive to dis­cov­er tru­ly great med­i­cines. To get a drug through the FDA you don’t have to prove the drug is bet­ter than a drug already on the mar­ket. All you have to prove is the drug is bet­ter than a placebo.

In 1992, the law changed to allow the drug com­pa­nies to pay large fees to the FDA so their drugs can be approved faster. Before 1992, the FDA had one cus­tomer and that was the pub­lic. Now the FDA has two cus­tomers: the pub­lic and the drug executives.

Is the sys­tem corrupt?

Some of these cas­es are incred­i­bly out­ra­geous. Like Vioxx, a pain reliev­er that 20 mil­lion Amer­i­c­as took before Mer­ck took it off the mar­ket because it increased the risk of a heart attack and stroke. The FDA esti­mat­ed that as many as 50,000 Amer­i­cans may have died from that drug.

Are there lawyers out there fight­ing the big phar­ma­ceu­ti­cal companies? 

Thou­sands of law­suits have been filed against the drug com­pa­nies. The fed­er­al gov­ern­ment has col­lect­ed bil­lions of dol­lars from the indus­try to set­tle charges of ille­gal mar­ket­ing. But the drug com­pa­nies just raise their prices, so they can pay out half a bil­lion dol­lars on law­suits, and con­tin­ue doing exact­ly what they have been doing. It’s an end­less cycle. I think some of the top phar­ma­ceu­ti­cal exec­u­tives should face crim­i­nal charges, so they would think twice about allow­ing these fraud­u­lent practices.

There is the sug­ges­tion of sim­ply ban­ning the phar­ma­ceu­ti­cal com­pa­nies from pay­ing off doctors.

The rule now is that the FDA will approve a drug for a cer­tain con­di­tion. A drug can be approved for depres­sion, for instance. And, the drug com­pa­nies are not sup­posed to mar­ket that drug for any­thing oth­er than depres­sion. But the doc­tor can pre­scribe the drug for what­ev­er they want. That is the loop­hole the drug com­pa­nies have tried to exploit. 

For exam­ple, exec­u­tives at Warn­er-Lam­bert, which is now part of Pfiz­er, decid­ed they want­ed the doc­tors to pre­scribe the epilep­sy drug Neu­ron­tin for atten­tion deficit dis­or­der, rest­less leg dis­or­der, bipo­lar dis­or­der. Just about any­thing that is relat­ed to the brain. 

So what Pfiz­er did was invite doc­tors to din­ner. The doc­tors were paid $500 to come to the din­ners and lis­ten to a speech by anoth­er physi­cian who would talk about how, even though Neu­ron­tin was approved for epilep­sy, they could also pre­scribe it for bipo­lar dis­or­der. Neu­ron­tin was soon a bil­lion-dol­lar drug, and 90 per­cent of the pre­scrip­tions were writ­ten for things oth­er than epilepsy.

Do you know of anoth­er indus­tri­al coun­try that does not nego­ti­ate with drug com­pa­nies for bet­ter prices?

No, the Unit­ed States is the only coun­try in the world that allows the drug com­pa­nies to charge what­ev­er they want.

You write that there are two phar­ma­ceu­ti­cal lob­by­ists for every mem­ber of Con­gress. What are they doing on Capi­tol Hill? 

The phar­ma­ceu­ti­cal indus­try fights against any mea­sure that threat­ens its prof­its. Present law gives the drug com­pa­nies a 20-year patent on each drug. Dur­ing that time, they have a monop­oly in the mar­ket. They can charge what­ev­er they want for that drug. They have fought against any mea­sure to allow more rea­son­able drug prices. 

There was this deal report­ed, and denied, that they met with Mr. Oba­ma and he agreed to help them.

Yes, the indus­try said they met with the pres­i­dent this past sum­mer and that in this meet­ing the com­pa­nies agreed to put $80 bil­lion on the table. But the drug com­pa­nies have been increas­ing prices like mad this year, so nobody is quite sure what this “$80 bil­lion” real­ly amounts to. In exchange for this $80 bil­lion, the drug exec­u­tives say that the pres­i­dent agreed not to change the law to allow Medicare to use its pur­chas­ing pow­er to nego­ti­ate drug prices and also agreed not to allow drugs to come from Cana­da, which are much low­er priced.

Just for com­par­i­son, the Vet­er­ans Admin­is­tra­tion does nego­ti­ate prices. And it gets a bet­ter deal than Medicare.

Yes, a much, much bet­ter deal. But with that off the table, the drug com­pa­nies are set up once again. If this health­care leg­is­la­tion pass­es they are going to get mil­lions of new patients and con­tin­ue to charge what­ev­er they wish. 

Where do you think health­care reform is headed? 

We need every­one to have access to health­care. But there is noth­ing in these bills that would con­trol costs. It’s not just the cost of drugs that is the prob­lem, it is the cost of every­thing. There have been stud­ies that show one-third to as much as one-half of the costs in our health­care sys­tem are unwar­rant­ed. Not only are many of those drugs not need­ed, they have side effects that can make peo­ple sick­er – but noth­ing in the pro­posed leg­is­la­tion makes our health­care sys­tem less expen­sive or safer.

Our whole health­care sys­tem is just dri­ven by this prof­i­teer­ing, and it’s not just the drug com­pa­nies. If we could get some mem­bers in Con­gress to stand up and say, We have had enough,” and if the pub­lic would get up and say, We have had enough,” maybe, Wash­ing­ton would listen. 

This exchange was adapt­ed from a pod­cast inter­view on Elec​tricPol​i​tics​.com.

George Ken­ney, a for­mer career U.S. for­eign ser­vice offi­cer, resigned in 1991 over U.S. pol­i­cy toward the Yugoslav con­flict. He is now a writer in Wash­ing­ton, and host and pro­duc­er of the pod­cast Elec­tric Pol­i­tics.
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